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APPLICATAN FOR CONSTRUC*ON PERN:►T� <br /> CITY OF EVEREI7•BUILDING DIVISION <br /> 3200 CEDAR STREET•EVERETT,WA 98201 •257•8870 <br /> ❑ DEMO!.ITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL O PLUMBING ❑ SIGN <br /> PROJECTADDRESS <br /> 5�a� - 14�h7Y� �J �`� <br /> O'.YNER RAILeDnORE55 biY EiV P11GIE <br /> �p�t'M S ��[w,d�i r�n �"�. C�� a'i <br /> 1EN�Ni MAIL��09E55 CIiT ZIP P11pYE <br /> MCHIiEGTOB�ESqNEP MAILADDPBS CILV ZIP pltOpE <br /> GE'IEP�tCONiFACTOR MAILAD�flESS LL' 21P PIION[ Si�IElKENSE� <br /> MECN,INIC0.CONIRACiOR M�ILAOOPE55 CIiY EIP CHOFE Si�IEIILENSE• <br /> PWMOINGCONif1.�Ci00 FIAIUOORE55 CIiY ZIP PIIONF. SLRELICENSC• <br /> COt iPniLE0Fw0�K <br /> r UUG HEATING SYSTEM: ❑GAS ❑ELECTFIIC ❑ <br /> 0 SCRiOE\V��eANOSW/.f1E�WiAGEItN0.VE� CONteLiP[fl50NNIDPIION[N0. <br /> � / <br /> � I HEREBY CERTIFY THAT I IIAVE READ AND E%AMINED THIS <br /> � ' � � pPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> enoaoseo use oc ommrta pROVISIONS OF LAWS AND ORDINANCES GOVERN WG 7HIS NPE OF <br /> WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iEGuorsrnicnoimFvaovEerv�snowe�oeLowonenneniwptoviEsl NOT. THE GRANTING OF A PERMIT �OES NOT PRESUh1E TO GNE <br /> �or oiaK ov AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERiORMANCE OF COYSTRl1CTION.THAT I AM AUTHOFIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION I$ MADE AND I COMPLY WITM THE STATE <br /> reAcc�uv io r+uuace CONT CTORS LAW 18.27 RCW AND 29G200 WAC. <br /> cor�srnucrior��o.wi[uocn,woxcss.rcicvror+cr+uuecn �„ �(, Q j20 �ZU�V <br /> icuemne –Z-�' oue <br /> arrouswes,�ktuserq. <br /> PLOlABING MECMANICAL <br /> N0. TVPE OF FI%TUNE OP ITEM FE'c N0. TYPE OF EOIIIPMENT FEE <br /> WATER CLOSET�TOILET� NC—PJFNDLG UNITS <br /> BATMTU� FORCED Ai9 SYSTEMS <br /> LAVATORY(bVASN BASIN� H[AT PU0.1P <br /> SHnSy�❑ j UNIT HEATEBS <br /> NITCHFH SINK 8 DISP CLOTHES�R'fERS <br /> DISMWFSHEH pqNGE HOOD <br /> LAUNDRVTRAY WATERHEATER <br /> CLOTHES LVASHGR WOOD STOVE <br /> URINAL � METAL FIREPLACE(WOOD BUPNING) <br /> DRINKING FOUNTAW FIflEPLACE INSERT(WOOD BURNING� <br /> FLOOR DRAIN GAS FIREPLAGE <br /> BACKFLOW PREVENTEi15 GAS RANG� <br /> SINN(SERVICE—OAR,ETC.) / GAS PIPiNG <br /> E%HAUSTFAN <br /> SUBTOTAL S SUBTOTAL S <br /> PERMIT S PERtAIT 4 <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: m � ��.� <br /> IPONTSET9PCIt REAqSEiBACK SIDES[T9ACK FUNCNELtlNUA10[q EE fiECEIPiNO <br /> Us[zoi�c LoreqEn vecurtSrtE FEES VALUATIDN FEE <br /> OVEi ❑NO OJIIDING <br /> IIEIGFiLiMliAtqN 1lOCFDWELLINO 52EOFpLIXYl1. <br /> urms <br /> PLIIIAB�Iq <br /> OCCUPMICY NJClSiONEi CLCUPNl1lOID OASEFIENT N[CINNiC.LL <br /> GPOUP <br /> ❑YES ❑NO <br /> iIRESPPiNCLCPPEO➢ PE�SON �DD�➢ONAIPtANC1�EtR <br /> OiNEP <br /> FlflEAURMRE00 FFASON <br /> $tAiE BWIOwG SUflLNMGE <br /> LYPEOfCONSi. PV.NSAiPPOYEp?V CITYOFEVEFETT PU9lICW011N5 <br /> LOCALSALES <br /> onrE TA%CODE153105 TOTAL <br />